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CASE
A 28 year old nulliparous woman presents for evaluation of irregular
menstrual cycles for the past year. Her periods come only every 2 or 3
months and she has gone as long as 4 months without a period. Currently,
she gives a last menstrual period of 11 weeks ago. She says she had
menarche at age 13 years and that her cycles have been mostly regular,
usually occurring every 30 days, but she would miss a cycle several times
a year. She has never been on hormonal contraception. She does not
smoke, does not drink alcohol, and does not exercise. She is sexually
active with single partner and uses condoms for contraception. On review
of systems, she reports a 30 1b weight gain in the past 18 month, but
otherwise has felt fine. On examination, she is noted to be obese, with a
body mass index of 30. Her vital signs are otherwise normal. She has fine
hair growth on her face and a velvety thickening of the skin on her neck.
Her general physical examination is normal. A pelvic examination reveals
normal external genitalia, no vaginal or cervical discharge, no cervical
motion tendernees, and no uterine or adnexal masses.
2. KEYWORD
1.
2.
3.
4.
5.
6.
7.
8.
9.
A 28 year
The last menstrual period of 11 weeks ago
Menarche at age 13 years
Her cycle have been mostly regular
Does not smoke, does not drink alcohol, and does not execise.
Body mass index of 30
Fine hair growth on her face
General examination is normal
No vaginal or cervical discharge
3. THEORY
4. ANALYSIS
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4.2 Definition
Irregular cycles or irregular periods is an abnormal variation in length of
menstrual cycles in a female. A textbook period happens every 24-29
days, but in truth what is regular covers a wide range. Cycles between
23-35 days are very common. A woman may get her period only one to
four times a year. Or she might have periods that occur 2-3 times in a
month and involve spotting or extremely heavy flow. Alternatively, she may
have heavy episodes of bleeding every 2-3 months. Irregular periods are
simply what is irregular for you.
For the most part, we dont worry at the clinic about a missed period or two
over the course of a year. More variation than that may indicate to us the
beginning of perimenopause or a disruption of the natural chain of
hormonal events that controls menstruation.
4.3 Etiology
Estrogen
Estrogen is responsible for thickening the uterine lining before
ovulation
Progesterone
Progesterone is responsible for trigerring the sed of the uterine
contens after ovulation when fertilization hasnt occurred
cysts,
polyps,
and
endometriosis)
Irritable bowel syndrome
Tuberculosis
Liver disease
Diabetes
Cancer
Anemia
Thyroid dysfunction
Lifestyle Triggers
- Significant weight gain / loss
- Over exercise
- Poor nutrition
- Smoking
- Drug use
- Caffeine
- Excessive alcohol use
- Medication use
- Breastfedding
- Increased stress
When we are stressed, regardless of the source (danger, personal
relationships, work, environment) our adrenal glands are designed to
secrete the hormone cortisol (read more in our articles in our Adrenal
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4.4 Patofisiology
Estrogen and progesterone disorder
deficit vit B6
your next. Repeat this for three months. If the number of days between
stopping and starting your period is significantly different each month, you
have an irregular cycle.
Food cravings
menopause
approaches,
women's
hormones
become
Blood clots
Missed periods
Painful cramping
4.8 Clasification
Other types of conditions that can be referred to by "irregular
menstruation" include:
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periods
should
have
been
regularly
established
4.9 Complications
For most women, an irregular period is nothing to be worried about; the
majority of women will eventually develop a regular cycle with regular
periods. Sometimes though, underlying complications can be the cause of
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and progesterone can disrupt the normal pattern of your period. That's
why young girls going through puberty and women approaching
menopause commonly have irregular periods.
Other common causes of irregular periods include:
Excessive exercise
Pregnancy or breastfeeding
Stress
Uterine fibroids
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Hormone therapy
Surgery
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irregularities and
premenstrual
syndrome,
though
You may have heard that completely darkening your room at night
will help regulate menstrual cycles but whether it really works is
unknown.
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options and talk to your doctor about how to get your menstrual
cycle back on track.
5.
Conclusion
If you are overweight, weight loss may be all the treatment you need. A
small amount of weight loss is likely to help balance your hormones
and start up your menstrual cycle and ovulation.
better.
If you smoke, consider quitting. Women who smoke have higher
lining from building up for too long. This can prevent uterine cancer.
Hormone therapy also can help with male-type hair growth and
acne. Birth control pills, patches, or vaginal rings are prescribed for
hormone therapy. Androgen-lowering spironolactone (Aldactone) is
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often used with combined hormonal birth control. This helps with
hair loss, acne, and male-pattern hair growth on the face and body
(hirsutism).
You can use other methods to treat acne and remove excess hair.
For more information, see Home Treatment.
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